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Current perspective on infections and mitigation strategies in primary systemic vasculitis

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Abstract

Purpose of Review

The purpose of this review is to summarize and evaluate most recent evidence on the epidemiology of infections and associated risk factors in patients with primary systemic vasculitides (PSV), as well as discuss mitigation strategies including the risk of antibiotic prophylaxis.

Recent Findings

Infections remain one of the leading causes of mortality in patients with PSV, with rates of severe infection ranging from 16 to 40% in different cohorts. Older age, frailty, renal and pulmonary involvement, and higher burden of comorbidities have been recognized as important patient-associated risk factors. Treatments including higher cumulative doses of glucocorticoids are associated with an increased risk of infections, and recent studies show the potential benefit of interventions such as reduced-dose glucocorticoid regimens. Existing mitigation strategies include screening, vaccination, and infection prophylaxis. The latter remains particularly important for Pneumocystis jirovecii pneumonia; however, the benefit-risk ratio seems to be less clear outside of induction phase (i.e., high dose of glucocorticoids) and optimal treatment duration remains less clear.

Summary

Patients with PSV are at increased risk of infections, due to disease itself, comorbidities, and treatment side effects. Awareness of the timing and types of infection, as well as mitigation strategies are imperative to ensure treatment success and survival for patients.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kitching AR, Anders H-J, Basu N, Brouwer E, Gordon J, Jayne DR, et al. ANCA-associated vasculitis. Nat Rev Dis Primer. 2020;6:71. https://doi.org/10.1038/s41572-020-0204-y.

    Article  Google Scholar 

  2. U.S. Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) v5.0 [Internet]. 2017 [cited 2024 Mar 30]. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf.

  3. Rathmann J, Jayne D, Segelmark M, Jönsson G, Mohammad AJ. Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study. Rheumatol Oxf Engl. 2021;60:2745–54. https://doi.org/10.1093/rheumatology/keaa699.

    Article  Google Scholar 

  4. Thomas K, Argyriou E, Kapsala N, Panagiotopoulos A, Chalkia A, Hadziyannis E, et al. Serious infections in ANCA-associated vasculitides in the biologic era: real-life data from a multicenter cohort of 162 patients. Arthritis Res Ther. 2021;23:90. https://doi.org/10.1186/s13075-021-02452-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Therkildsen P, de Thurah A, Nielsen BD, Faurschou M, Baslund B, Hansen IT, et al. The one-year infection risk among patients diagnosed with giant cell arteritis: use of antibiotics and hospitalisations. Rheumatol Oxf Engl. 2024:keae107. https://doi.org/10.1093/rheumatology/keae107.

  6. Monti S, Milanesi A, Klersy C, Tomelleri A, Dagna L, Campochiaro C, et al. Age at diagnosis influences the clinical phenotype, treatment strategies and outcomes in patients with giant cell arteritis: results from the observational GCAGE study on a large cohort of 1004 patients. Ann Rheum Dis. 2023;82:1098–106. https://doi.org/10.1136/ard-2023-223895.

    Article  PubMed  Google Scholar 

  7. . Tedeschi SK, Jin Y, Vine S, Lee H, Pethoe-Schramm A, Yau V, et al. Giant cell arteritis treatment patterns and rates of serious infections. Clin Exp Rheumatol. 2022;40:826–33. https://doi.org/10.55563/clinexprheumatol/uonz1p. Large national analysis of treatment patterns and infection in individuals with GCA.

    Article  PubMed  Google Scholar 

  8. Singh JA, Cleveland JD. Serious infections in people with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA): a time-trend national US study. Clin Rheumatol. 2020;39:3427–38. https://doi.org/10.1007/s10067-020-05129-w.

    Article  PubMed  Google Scholar 

  9. Nossent J, Raymond W, Isobel Keen H, Preen D, Inderjeeth C. Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study. Rheumatol Oxf Engl. 2021;61:291–8. https://doi.org/10.1093/rheumatology/keab312.

    Article  Google Scholar 

  10. Caillard P, Vigneau C, Halimi J-M, Hazzan M, Thervet E, Heitz M, et al. Severe Infection in Anti-Glomerular Basement Membrane Disease: A Retrospective Multicenter French Study. J Clin Med. 2020;9:698. https://doi.org/10.3390/jcm9030698.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Vassilopoulos A, Vassilopoulos S, Kalligeros M, Shehadeh F, Mylonakis E. Incidence of serious infections in patients with ANCA-associated vasculitis receiving immunosuppressive therapy: A systematic review and meta-analysis. Front Med. 2023;10:1110548. https://doi.org/10.3389/fmed.2023.1110548.

    Article  Google Scholar 

  12. Steinberg AW, Wechsler ME, Fernández Pérez ER. Trends in Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis-Related Mortality in the United States, 1999 to 2017. Ann Intern Med. 2020;172:160–3. https://doi.org/10.7326/m19-1564.

    Article  PubMed  Google Scholar 

  13. Wallace ZS, Fu X, Harkness T, Stone JH, Zhang Y, Choi H. All-cause and cause-specific mortality in ANCA-associated vasculitis: overall and according to ANCA type. Rheumatol Oxf Engl. 2020;59:2308–15. https://doi.org/10.1093/rheumatology/kez589.

    Article  CAS  Google Scholar 

  14. Shuai Z-Q, Zhang C-X, Shuai Z-W, Ge S-L. Efficacy and safety of biological agents in the treatment of patients with Takayasu arteritis: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25:250–62. https://doi.org/10.26355/eurrev_202101_24391.

    Article  PubMed  Google Scholar 

  15. World Health Organization. Global tuberculosis report 2022 [Internet]. Geneva: World Health Organization; 2022. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022

    Google Scholar 

  16. Li L, Zhou F, Li F, Chen J, Xie X. Prevalence of tuberculosis infection among patients with Takayasu arteritis: a meta-analysis of observational studies. Sci Rep. 2023;13:22481. https://doi.org/10.1038/s41598-023-49998-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K. Validation of the rheumatic disease comorbidity index. Arthritis Care Res. 2015;67:865–72. https://doi.org/10.1002/acr.22456.

    Article  Google Scholar 

  18. Thietart S, Karras A, Augusto J-F, Philipponnet C, Carron P-L, Delbrel X, et al. Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. JAMA Netw Open. 2022;5:e2220925. https://doi.org/10.1001/jamanetworkopen.2022.20925.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bloom JL, Pickett-Nairn K, Silveira L, Fuhlbrigge RC, Cuthbertson D, Akuthota P, et al. The Association Between Age at Diagnosis and Disease Characteristics and Damage in Patients With ANCA-Associated Vasculitis. Arthritis Rheumatol Hoboken NJ. 2023;75:2216–27. https://doi.org/10.1002/art.42651.

    Article  CAS  Google Scholar 

  20. Osman M, Pagnoux C, Dryden DM, Storie D, Yacyshyn E. The role of biological agents in the management of large vessel vasculitis (LVV): a systematic review and meta-analysis. PloS One. 2014;9:e115026. https://doi.org/10.1371/journal.pone.0115026.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in Older Adults: A Nationally Representative Profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70:1427–34. https://doi.org/10.1093/gerona/glv133.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sattui S, Fu X, Cook C, Srivatsan S, Zhang Y, Wallace Z. The Impact of Chronologic versus Biologic Age on the Risk of Severe Infection, End-Stage Renal Disease, and Death in Older Adults with ANCA-Associated Vasculitis. In: ACR Meet Abstr [Internet]. San Diego, CA; 2023. Available from: https://acrabstracts.org/abstract/the-impact-of-chronologic-versus-biologic-age-on-the-risk-of-severe-infection-end-stage-renal-disease-and-death-in-older-adults-with-anca-associated-vasculitis/.

  23. Sattui S, Stadler J, Borchin R, Burroughs C, Yeung C, Merkel P, et al. The Association of Frailty with Outcomes in Patients with Vasculitis. In: ACR Meet Abstr [Internet]. San Diego, CA; 2023. Available from: https://acrabstracts.org/abstract/the-association-of-frailty-with-outcomes-in-patients-with-vasculitis/.

  24. Uslu Yurteri E, Sezer S, Torgutalp M, Yayla ME, Sahin Eroglu D, Okatan IE, et al. The factors predicting development of serious infections in ANCA-associated vasculitis. Sarcoidosis Vasc Diffuse Lung Dis Off J WASOG. 2023;40:e2023015. https://doi.org/10.36141/svdld.v40i2.13243.

    Article  Google Scholar 

  25. Kronbichler A, Kerschbaum J, Gopaluni S, Tieu J, Alberici F, Jones RB, et al. Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis. Ann Rheum Dis. 2018;77:1440–7. https://doi.org/10.1136/annrheumdis-2017-212861.

    Article  CAS  PubMed  Google Scholar 

  26. Haris Á, Polner K, Arányi J, Braunitzer H, Kaszás I. Incidence and clinical predictors of infections in patients treated with severe systemic ANCA-associated vasculitis. Physiol Int. 2021; https://doi.org/10.1556/2060.2021.00006.

  27. Sarica SH, Gallacher PJ, Dhaun N, Sznajd J, Harvie J, McLaren J, et al. Multimorbidity in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results From a Longitudinal, Multicenter Data Linkage Study. Arthritis Rheumatol Hoboken NJ. 2021;73:651–9. https://doi.org/10.1002/art.41557.

    Article  CAS  Google Scholar 

  28. . Furuta S, Nakagomi D, Kobayashi Y, Hiraguri M, Sugiyama T, Amano K, et al. Effect of Reduced-Dose vs High-Dose Glucocorticoids Added to Rituximab on Remission Induction in ANCA-Associated Vasculitis: A Randomized Clinical Trial. JAMA. 2021;325:2178–87. https://doi.org/10.1001/jama.2021.6615. RCT comparing standard vs low-dose glucocorticoid regimens in AAV showing lower risk of incident infections.

    Article  CAS  PubMed  Google Scholar 

  29. . Walsh M, Merkel PA, Peh C-A, Szpirt WM, Puéchal X, Fujimoto S, et al. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. N Engl J Med. 2020;382:622–31. https://doi.org/10.1056/nejmoa1803537. RCT showing lower risk of incident infections and similar outcomes with low-dose glucocorticoid regimen in individuals with severe AAV.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. DRW J, Merkel PA, Schall TJ, Bekker P, ADVOCATE Study Group. Avacopan for the Treatment of ANCA-Associated Vasculitis. N Engl J Med. 2021;384:599–609. https://doi.org/10.1056/nejmoa2023386.

    Article  CAS  Google Scholar 

  31. Nagle S, Nguyen Y, Puéchal X, Titeca-Beauport D, Crépin T, Mesbah R, et al. Real-life Use of the PEXIVAS Reduced-dose Glucocorticoid Regimen in Granulomatosis with Polyangiitis and Microscopic Polyangiitis. In: ACR Meet Abstr [Internet]. San Diego, CA; 2023. Available from: https://acrabstracts.org/abstract/real-life-use-of-the-pexivas-reduced-dose-glucocorticoid-regimen-in-granulomatosis-with-polyangiitis-and-microscopic-polyangiitis/.

  32. Hellmich B, Sanchez-Alamo B, Schirmer JH, Berti A, Blockmans D, Cid MC, et al. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis. 2024;83:30–47. https://doi.org/10.1136/ard-2022-223764.

    Article  PubMed  Google Scholar 

  33. Chung SA, Langford CA, Maz M, Abril A, Gorelik M, Guyatt G, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Care Res. 2021;73:1088–105. https://doi.org/10.1002/acr.24634.

    Article  Google Scholar 

  34. . Thery-Casari C, Euvrard R, Mainbourg S, Durupt S, Reynaud Q, Durieu I, et al. Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitides receiving rituximab: A meta-analysis. Autoimmun Rev. 2020;19:102505. https://doi.org/10.1016/j.autrev.2020.102505. Meta-analysis analyzing incidence of severe infections and risk factors in individuals with AAV receiving treatment with rituximab.

    Article  CAS  PubMed  Google Scholar 

  35. . Odler B, Riedl R, Gauckler P, Shin JI, Leierer J, Merkel PA, et al. Risk factors for serious infections in ANCA-associated vasculitis. Ann Rheum Dis. 2023;82:681–7. https://doi.org/10.1136/ard-2022-223401. Post-hoc analysis of RAVE study showing decreased risk of infections associated to use of antibiotic prophylaxis.

    Article  CAS  PubMed  Google Scholar 

  36. Md Yusof MY, Vital EM, McElvenny DM, Hensor EMA, Das S, Dass S, et al. Predicting Severe Infection and Effects of Hypogammaglobulinemia During Therapy With Rituximab in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol Hoboken NJ. 2019;71:1812–23. https://doi.org/10.1002/art.40937.

    Article  CAS  Google Scholar 

  37. Habibi MA, Alesaeidi S, Zahedi M, Hakimi Rahmani S, Piri SM, Tavakolpour S. The Efficacy and Safety of Rituximab in ANCA-Associated Vasculitis: A Systematic Review. Biology. 2022;11:1767. https://doi.org/10.3390/biology11121767.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Roberts DM, Jones RB, Smith RM, Alberici F, Kumaratne DS, Burns S, et al. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun. 2015;57:60–5. https://doi.org/10.1016/j.jaut.2014.11.009.

    Article  CAS  PubMed  Google Scholar 

  39. Padoan R, Felicetti M, Gatto M, Polito P, Doria A, Schiavon F. Rituximab-associated hypogammaglobulinaemia in ANCA-associated vasculitis and connective tissue diseases: a longitudinal observational study. Clin Exp Rheumatol. 2020;38(Suppl 124):188–94.

    PubMed  Google Scholar 

  40. Opdam MAA, Campisi LM, de Leijer JH, Ten Cate D, den Broeder AA. Hypogammaglobulinemia in rheumatoid arthritis patients on rituximab: prevalence and risk factors. Rheumatol Oxf Engl. 2024;63:e1–2. https://doi.org/10.1093/rheumatology/kead326.

    Article  Google Scholar 

  41. . Omura S, Kida T, Noma H, Sunaga A, Kusuoka H, Kadoya M, et al. Association between hypogammaglobulinaemia and severe infections during induction therapy in ANCA-associated vasculitis: from J-CANVAS study. Rheumatol Oxf Engl. 2023;62:3924–31. https://doi.org/10.1093/rheumatology/kead138. Longitudinal study showing association between hypogammaglobulinemia and incident infections in individuals with AAV.

    Article  CAS  Google Scholar 

  42. Smith RM, Jones RB, Specks U, Bond S, Nodale M, Al-Jayyousi R, et al. Rituximab versus azathioprine for maintenance of remission for patients with ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial. Ann Rheum Dis. 2023;82:937–44. https://doi.org/10.1136/ard-2022-223559.

    Article  CAS  PubMed  Google Scholar 

  43. Mescia F, Salviani C, Tonoli M, Affatato S, Moratto D, Tedesco M, et al. Sustained post-rituximab B-cell depletion is common in ANCA-associated vasculitis and is affected by sex and renal function. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2024;39:683–93. https://doi.org/10.1093/ndt/gfad197.

    Article  Google Scholar 

  44. Dua AB, Husainat NM, Kalot MA, Byram K, Springer JM, James KE, et al. Giant Cell Arteritis: A Systematic Review and Meta-Analysis of Test Accuracy and Benefits and Harms of Common Treatments. ACR Open Rheumatol. 2021;3:429–41. https://doi.org/10.1002/acr2.11226.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Alibaz-Oner F, Kaymaz-Tahra S, Bayındır Ö, Yazici A, Ince B, Kalkan K, et al. Biologic treatments in Takayasu’s Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab. Semin Arthritis Rheum. 2021;51:1224–9. https://doi.org/10.1016/j.semarthrit.2021.09.010.

    Article  CAS  PubMed  Google Scholar 

  46. Tian X, Li M, Jiang N, Zhao Y, Li J, Zhou Y, et al. Comparative Efficacy of Secukinumab Versus Tumor Necrosis Factor Inhibitors for the Treatment of Takayasu Arteritis. Arthritis Rheumatol Hoboken NJ. 2023;75:1415–23. https://doi.org/10.1002/art.42496.

    Article  CAS  Google Scholar 

  47. Walsh M, Collister D, Zeng L, Merkel PA, Pusey CD, Guyatt G, et al. The effects of plasma exchange in patients with ANCA-associated vasculitis: an updated systematic review and meta-analysis. BMJ. 2022;376:e064604. https://doi.org/10.1136/bmj-2021-064604.

    Article  PubMed  Google Scholar 

  48. Walsh M, Casian A, Flossmann O, Westman K, Höglund P, Pusey C, et al. Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear. Kidney Int. 2013;84:397–402. https://doi.org/10.1038/ki.2013.131.

    Article  CAS  PubMed  Google Scholar 

  49. Merkel PA, Niles J, Jimenez R, Spiera RF, Rovin BH, Bomback A, et al. Adjunctive Treatment With Avacopan, an Oral C5a Receptor Inhibitor, in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. ACR Open Rheumatol. 2020;2:662–71. https://doi.org/10.1002/acr2.11185.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Jayne DRW, Bruchfeld AN, Harper L, Schaier M, Venning MC, Hamilton P, et al. Randomized Trial of C5a Receptor Inhibitor Avacopan in ANCA-Associated Vasculitis. J Am Soc Nephrol JASN. 2017;28:2756–67. https://doi.org/10.1681/asn.2016111179.

    Article  CAS  PubMed  Google Scholar 

  51. Bekker P, Merkel P, Jayne D. Safety of Avacopan in ANCA-Associated Vasculitis: Combined Data from Three Clinical Trials. In: ACR Meet Abstr [Internet]. Philadelphia, PA; 2022. Available from: https://acrabstracts.org/abstract/safety-of-avacopan-in-anca-associated-vasculitis-combined-data-from-three-clinical-trials/.

  52. van Leeuwen JR, Popov T, Obergfell A, Rabelink TJ, Teng YKO. Preliminary Assessment of Safety and Tolerability of Avacopan During the Early Access Program for ANCA-Associated Vasculitis. Biol Targets Ther. 2023;17:11–4. https://doi.org/10.2147/btt.s394843.

    Article  CAS  Google Scholar 

  53. Holroyd CR, Seth R, Bukhari M, Malaviya A, Holmes C, Curtis E, et al. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis-Executive summary. Rheumatol Oxf Engl. 2019;58:220–6. https://doi.org/10.1093/rheumatology/key207.

    Article  CAS  Google Scholar 

  54. Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, et al. Viral hepatitis screening guideline before biological drug use in rheumatic patients. Eur J Rheumatol. 2016;3:25–8. https://doi.org/10.5152/eurjrheum.2015.150072.

    Article  PubMed  Google Scholar 

  55. Kim DK, Bridges CB, Harriman KH, Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), ACIP Adult Immunization Work Group. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older--United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:91–2.

    PubMed  PubMed Central  Google Scholar 

  56. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001;345:1098–104. https://doi.org/10.1056/nejmoa011110.

    Article  CAS  PubMed  Google Scholar 

  57. Ruan Q, Zhang S, Ai J, Shao L, Zhang W. Screening of latent tuberculosis infection by interferon-γ release assays in rheumatic patients: a systemic review and meta-analysis. Clin Rheumatol. 2016;35:417–25. https://doi.org/10.1007/s10067-014-2817-6.

    Article  PubMed  Google Scholar 

  58. . Sattui SE, Wallace ZS. Managing Immunosuppression in Vasculitis Patients in Times of Coronavirus Disease 2019. Rheum Dis Clin North Am. 2023;49:695–711. https://doi.org/10.1016/j.rdc.2023.03.007. Review on incidence, risk and mitigation strategies for COVID-19 infection in individuals with vasculitis.

    Article  PubMed  PubMed Central  Google Scholar 

  59. . Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Care Res. 2023;75:449–64. https://doi.org/10.1002/acr.25045. Guidelines for vaccination in individuals with rheumatic diseases.

    Article  Google Scholar 

  60. Park JK, Lee MA, Lee EY, Song YW, Choi Y, Winthrop KL, et al. Effect of methotrexate discontinuation on efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2017;76:1559–65. https://doi.org/10.1136/annrheumdis-2017-211128.

    Article  CAS  PubMed  Google Scholar 

  61. Abhishek A, Peckham N, Pade C, Gibbons JM, Cureton L, Francis A, et al. Effect of a 2-week interruption in methotrexate treatment on COVID-19 vaccine response in people with immune-mediated inflammatory diseases (VROOM study): a randomised, open label, superiority trial. Lancet Rheumatol. 2024;6:e92–104. https://doi.org/10.1016/s2665-9913(23)00298-9.

    Article  CAS  PubMed  Google Scholar 

  62. van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70:414–22. https://doi.org/10.1136/ard.2010.137216.

    Article  CAS  PubMed  Google Scholar 

  63. Bingham CO, Looney RJ, Deodhar A, Halsey N, Greenwald M, Codding C, et al. Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum. 2010;62:64–74. https://doi.org/10.1002/art.25034.

    Article  CAS  PubMed  Google Scholar 

  64. Adler S, Krivine A, Weix J, Rozenberg F, Launay O, Huesler J, et al. Protective effect of A/H1N1 vaccination in immune-mediated disease--a prospectively controlled vaccination study. Rheumatol Oxf Engl. 2012;51:695–700. https://doi.org/10.1093/rheumatology/ker389.

    Article  CAS  Google Scholar 

  65. Ribeiro ACM, Guedes LKN, Moraes JCB, Saad CGS, Aikawa NE, Calich AL, et al. Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice. Ann Rheum Dis. 2011;70:2144–7. https://doi.org/10.1136/ard.2011.152983.

    Article  PubMed  Google Scholar 

  66. . Terrier B, Richert L, Pugnet G, Aumaitre O, Moranne O, Diot E, et al. Innovative Anti-pneumococcal Vaccine Strategies versus Standard Vaccination Regimen in Patients with ANCA-associated Vasculitides Receiving Rituximab Therapy: A Multicenter Randomized Controlled Trial (PNEUMOVAS). ACR Meet Abstr [Internet]. Philadelphia, PA; 2022 [cited 2024 Mar 14]. Available from: https://acrabstracts.org/abstract/innovative-anti-pneumococcal-vaccine-strategies-versus-standard-vaccination-regimen-in-patients-with-anca-associated-vasculitides-receiving-rituximab-therapy-a-multicenter-randomized-controlled-trial/RCT on different regimens of pneumococcal vaccination in individuals with AAV receiving treatment with rituximab.

  67. Ghembaza A, Vautier M, Cacoub P, Pourcher V, Saadoun D. Risk Factors and Prevention of Pneumocystis jirovecii Pneumonia in Patients With Autoimmune and Inflammatory Diseases. Chest. 2020;158:2323–32. https://doi.org/10.1016/j.chest.2020.05.558.

    Article  CAS  PubMed  Google Scholar 

  68. Park JW, Curtis JR, Moon J, Song YW, Kim S, Lee EB. Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis. 2018;77:644–9. https://doi.org/10.1136/annrheumdis-2017-211796.

    Article  CAS  PubMed  Google Scholar 

  69. . Park JW, Curtis JR, Choi SR, Kim MJ, Ha Y-J, Kang EH, et al. Risk-Benefit Analysis of Primary Prophylaxis Against Pneumocystis Jirovecii Pneumonia in Patients With Rheumatic Diseases Receiving Rituximab. Arthritis Rheumatol Hoboken NJ. 2023;75:2036–44. https://doi.org/10.1002/art.42541. Large national study assessing risk of incident PJP infection in patients receiving treatment with rituximab, including NNT and NNH calculations.

    Article  CAS  Google Scholar 

  70. . Nettleton E, Sattui SE, Wallace Z, Putman M. Incidence of Pneumocystis Jiroveci Pneumonia in Patients With ANCA-Associated Vasculitis Initiating Therapy With Rituximab or Cyclophosphamide. Arthritis Care Res. 2024;76:288–94. https://doi.org/10.1002/acr.25222. Large contemporary study assessing incidence of PJP in individuals with AAV.

    Article  CAS  Google Scholar 

  71. . Anumolu N, Henry K, Sattui SE, Putman M. Is there a role for Pneumocystis jiroveci pneumonia prophylaxis in giant cell arteritis or polymyalgia rheumatica? Semin Arthritis Rheum. 2023;58:152154. https://doi.org/10.1016/j.semarthrit.2022.152154. Large contemporary study assessing incidence of PJP in individuals with GCA and polymyalgia rheumatica.

    Article  CAS  PubMed  Google Scholar 

  72. Fraenkel L, Bathon JM, England BR, St Clair EW, Arayssi T, Carandang K, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res. 2021;73:924–39. https://doi.org/10.1002/acr.24596.

    Article  Google Scholar 

  73. Terrault NA, Lok ASF, McMahon BJ, Chang K-M, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatol Baltim Md. 2018;67:1560–99. https://doi.org/10.1002/hep.29800.

    Article  Google Scholar 

  74. Koutsianas C, Thomas K, Vassilopoulos D. Reactivation of hepatitis B virus infection in rheumatic diseases: risk and management considerations. Ther Adv Musculoskelet Dis. 2020;12:1759720X20912646. https://doi.org/10.1177/1759720x20912646.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT. American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215–9. https://doi.org/10.1053/j.gastro.2014.10.039.

    Article  CAS  PubMed  Google Scholar 

  76. . Wijetilleka S, Jayne DR, Mukhtyar C, Ala A, Bright PD, Chinoy H, et al. Recommendations for the management of secondary hypogammaglobulinaemia due to B cell targeted therapies in autoimmune rheumatic diseases. Rheumatol Oxf Engl. 2019;58:889–96. https://doi.org/10.1093/rheumatology/key394. Guidance on use of IVIG in individuals with hypogammaglobulinemia secondary to BCDT.

    Article  CAS  Google Scholar 

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Acknowledgements

Figure 1 was created with Biorender.com.

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Author notes

  1. MCT and RLS contributed equally and are co-first authors.

Authors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA

    Manuel Carpio Tumba & Sebastian E. Sattui

  2. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Raisa Lomanto Silva

  3. Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Massachusetts, Boston, MA, USA

    Ana B. Arevalo

Authors
  1. Manuel Carpio Tumba
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  2. Raisa Lomanto Silva
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  3. Ana B. Arevalo
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  4. Sebastian E. Sattui
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Contributions

MCT, RLS, ABA, and SES wrote, reviewed, and edited the manuscript. MCT and SES prepared Table 1. RLS and SES prepared Figure 1.

All authors have reviewed the final manuscript and approved its submission.

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Correspondence to Sebastian E. Sattui.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

Competing Interests

SES receives funding from the Bristol Myers Squibb Foundation Robert A. Winn Diversity in Clinical Trials Career Development Award. SES has received research support from AstraZeneca and GlaxoSmithKline (clinical trials). SES has participated in advisory boards and provided consulting for Sanofi and Amgen (all funds towards research support), and received speaker fees from Fresenius Kabi (funds toward research support).

MCT, RLS, and ABA report no disclosures.

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Tumba, M.C., Silva, R.L., Arevalo, A.B. et al. Current perspective on infections and mitigation strategies in primary systemic vasculitis. Curr Rheumatol Rep (2024). https://doi.org/10.1007/s11926-024-01149-6

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